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Staubitz-Vernazza JI, Müller C, Heymans A, Nedwed AS, Schindeldecker M, Hartmann M, Kloth M, Schad A, Roth W, Musholt TJ, Hartmann N. Gene Expression Profiles of AHNAK2, DCSTAMP, FN1, and TERT Correlate With Mutational Status and Recurrence in Papillary Thyroid Carcinoma. Genes Chromosomes Cancer 2024; 63:e23256. [PMID: 39193983 DOI: 10.1002/gcc.23256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/11/2024] [Accepted: 06/19/2024] [Indexed: 08/29/2024] Open
Abstract
Papillary thyroid carcinoma (PTC), the most common malignancy of follicular cell derivation, is generally associated with good prognosis. Nevertheless, it is important to identify patients with aggressive PTCs and unfavorable outcome. Molecular markers such as BRAFV600E mutation and TERT promoter mutations have been proposed for risk stratification. While TERT promoter mutations have been frequently associated with aggressive PTCs, the association of BRAFV600E mutation with increased recurrence and mortality is less clear and has been controversially discussed. The aim of the present study was to analyze whether differentially expressed genes can predict BRAFV600E mutations as well as TERT promoter mutations in PTCs. RNA sequencing identified a large number of differentially expressed genes between BRAFV600E and BRAFwildtype PTCs. Of those, AHNAK2, DCSTAMP, and FN1 could be confirmed in a larger cohort (n = 91) to be significantly upregulated in BRAFV600E mutant PTCs using quantitative RT-PCR. Moreover, individual PTC expression values of DCSTAMP and FN1 were able to predict the BRAFV600E mutation status with high sensitivity and specificity. The expression of TERT was detected in all PTCs harboring TERT promoter mutations and in 19% of PTCs without TERT promoter mutations. Tumors with both TERT expression and TERT promoter mutations were particularly associated with aggressive clinicopathological features and a shorter recurrence-free survival. Altogether, it will be interesting to explore the biological function of AHNAK2, DCSTAMP, and FN1 in PTC in more detail. The analysis of their expression patterns could allow the characterization of PTC subtypes and thus enabling a more individualized surgical and medical treatment.
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Affiliation(s)
- Julia I Staubitz-Vernazza
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Celine Müller
- Institute of Pathology, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Antonia Heymans
- Institute of Pathology, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Annekathrin Silvia Nedwed
- Institute for Medical Biometry, Epidemiology and Informatics, University Medical Centre Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Mario Schindeldecker
- Institute of Pathology, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Monika Hartmann
- Department of Medicine III, University Medical Centre Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Michael Kloth
- Institute of Pathology, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Arno Schad
- Institute of Pathology, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Wilfried Roth
- Institute of Pathology, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Thomas J Musholt
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Nils Hartmann
- Institute of Pathology, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
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Staubitz JI, Poplawski A, Watzka F, Musholt TJ. Real-world EUROCRINE ® registry data challenge the reliability of Bethesda cytopathology for thyroid surgery indication. Innov Surg Sci 2022; 7:99-106. [PMID: 36561503 PMCID: PMC9742262 DOI: 10.1515/iss-2021-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/19/2021] [Indexed: 12/25/2022] Open
Abstract
Objectives Fine-needle aspiration cytology (FNAC) is recommended by international guidelines for the preoperative evaluation of suspicious thyroid nodules >1 cm. Despite robust evidence from endocrine centers demonstrating the key role of FNAC results for the indication of surgery, the method is not routinely used in European clinics. The database EUROCRINE®, which was introduced in 2015 with the scope of registering operations of the endocrine system, allows for a large-scale analysis of the current service reality in Europe concerning FNAC use and associated accuracy. Methods Operations performed to "exclude malignancy", registered from January 2015 to December 2018 in EUROCRINE®, were analyzed. Parameters of accuracy were calculated for FNAC. FNAC results were considered "test positive" in the case of Bethesda category IV, V, and VI, since these categories usually prompt surgical interventions in European centers for thyroid surgery. Bethesda category II and III were considered "test negative". Results Of 8,791 operations, 5,780 had preoperative FNAC (65.7%). The overall malignancy rate was 28.3% (2,488/8,791). Malignancy rates were 68.8% for Bethesda VI, 69.9% for Bethesda V, 32.6% for Bethesda IV, 28.2% for III, 20.2% for Bethesda II, and 24.5% for Bethesda I. After exclusion of papillary microcarcinomas (PTMCs), the sensitivity of FNAC was 71.7% and specificity 43.5%, the positive predictive value was 29.1% and the negative predictive value 82.7%. Conclusions Although the indication to "exclude malignancy" was the predominant reason that prompted thyroid resection in the present cohort, FNAC was only used in about 65.7% of cases. When performed, FNAC was associated with unexpectedly low accuracy. Interestingly, in Bethesda II, 20.2% of malignant entities were present (13.3% after the exclusion of PTMCs).
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Affiliation(s)
- Julia I. Staubitz
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Alicia Poplawski
- Institute for Medical Biometry, Epidemiology and Informatics, University Medical Centre Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Felix Watzka
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas J. Musholt
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
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Namdeo RB, Janardan GV. Thyroid Disorder Diagnosis by Optimal Convolutional Neuron based CNN Architecture. J EXP THEOR ARTIF IN 2021. [DOI: 10.1080/0952813x.2021.1938694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Rajole Bhausaheb Namdeo
- Department of Electronics & Telecommunication Engineering, Research Scholar Matoshri Education Society’s Matoshri College of Engineering & Research Centre, Nashik
| | - Gond Vitthal Janardan
- Professor, Department of Electronics & Telecommunication Engineering, MET’s Institute of Engineering, Nashik
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Thyroid and Molecular Testing. Advances in Thyroid Molecular Cytopathology. JOURNAL OF MOLECULAR PATHOLOGY 2021. [DOI: 10.3390/jmp2020008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Thyroid nodules are a common finding in the adult population including the fact that more than 50% of individuals, over the age of 60, have thyroid nodules. The majority have been mostly detected with ultrasonography and 10% by palpation. The majority of these nodules are benign, whereas 5–15% of them are malignant. The pre-operative diagnosis of cancer is a critical challenge in order to ensure that each patient can be treated with the best tailored management with a reduction of unnecessary surgery for benign lesions. Fine needle aspiration cytology (FNAC) represents the first and most important diagnostic tool for the evaluation of thyroid lesions. According to the literature, FNAC is able to render a conclusive diagnosis in up to 70–80% of all cases. For the remaining 20–30% of nodules, cytological diagnoses fall into the category of indeterminate lesions mostly due to the lack of specific morphological features. According to the Bethesda system for reporting thyroid cytopathology (TBSRTC), indeterminate lesions can be sub-stratified into three different subcategories including “atypia of undetermined significance/follicular lesion of undetermined significance-AUS/FLUS”; “follicular or Hürthle cell neoplasm/suspicious for follicular or Hürthle cell neoplasm-FN/SFN”; and “suspicious for malignancy-SFM”. Many of these indeterminate lesions undergo repetition or diagnostic lobectomy. Nonetheless, the majority of these cases will have a benign diagnosis due to the fact that the rate of cancer ranges between 6 and 30%. It stands to reason that the application of ancillary technique, mostly molecular testing, emerged as a critical additional tool for those thyroid indeterminate lesions. Since the early 1990s, material collected from cytological samples yields sufficient and adequate cells for the detection of point mutation or gene fusions. Nonetheless, the further availability of new sequencing technologies such as next-generation sequencing (NGS) has led to more comprehensive molecular applications adopted now in clinical use. The current review investigates the multiple advances in the field of molecular testing applied in thyroid cytology.
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Rashid FA, Munkhdelger J, Fukuoka J, Bychkov A. Prevalence of BRAFV600E mutation in Asian series of papillary thyroid carcinoma-a contemporary systematic review. Gland Surg 2020; 9:1878-1900. [PMID: 33224863 PMCID: PMC7667088 DOI: 10.21037/gs-20-430] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/04/2020] [Indexed: 12/30/2022]
Abstract
Papillary thyroid carcinoma (PTC), the most common malignancy of the endocrine system, is frequently driven by BRAFV600E mutation, which was reported in 35-60% cases in Western series. Numerous studies have recently emerged from Asian countries and regions; however sufficient summary is lacking to date. BRAF mutation serves as a diagnostic and prognostic tool in thyroid cancer, therefore establishing a rate of BRAF on the national scale could be of practical significance. We performed systematic reviews of available literature to investigate the prevalence of BRAF mutation in series of PTC from various Asian countries and regions. Out of the total 3,966 reports identified via initial screening, 138 studies encompassing over 40,000 PTCs were included for the final analysis. A vast majority (90.2%) of PTCs with known BRAF status were from East Asia, including China, South Korea, and Japan, with BRAF mutation rates of 71.2%, 75.5%, and 70.6%, respectively. Less abundant Indian and Saudi Arabian series found 45.6% and 46.3% prevalence of BRAFV600E in PTC, respectively. Much limited evidence was available from Thailand, Iran, Kazakhstan, Taiwan, Singapore, Indonesia, Hong Kong, Philippines, Vietnam, Iraq, and Myanmar. No relevant publications were found from other highly populated countries, such as Pakistan, Bangladesh, and Malaysia. After grouping by geographic region, we found that the highest rate of BRAFV600E was reported in the PTC series from East Asia (76.4%). Much lower rate (45-48%) was seen in PTC cohorts from South Asia, Central Asia, and the Middle East while the Southeast Asian series were in between (57%). Further subgroup analysis revealed that studies employing fresh frozen tissue and fine-needle aspirates showed higher rates of BRAF compared to those used formalin-fixed paraffin-embedded tissues. We found that the PTC series enrolled patients' cohorts after 2010 demonstrated a higher rate of BRAF compared to the earlier series. Finally, pediatric PTCs had lower BRAF prevalence compared to the baseline rate for the country. In conclusion, despite considerable among and within countries heterogeneity, the Asian PTC series showed a higher prevalence of BRAFV600E mutation than that in Western series. Causes of geographic heterogeneity, whether genuine (etiology, genetics) or methodology-related should be further investigated.
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Affiliation(s)
- Faiza Abdul Rashid
- Department of Biological Sciences, Faculty of Basic and Applied Sciences, International Islamic University, Islamabad, Pakistan
| | | | - Junya Fukuoka
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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6
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Abstract
Fine-needle aspiration (FNA) is among the first diagnostic tools used in the evaluation of thyroid nodules. It has the ability to triage patients with benign and malignant lesions, thus defining the optimum clinical and/or surgical management. The Bethesda System for Reporting Thyroid Cytopathology has found worldwide acceptance. Thyroid FNA offers high positive predictive value (97%-99%), with sensitivities and specificities of 65% to 99% and 72% to 100%, respectively. Nonetheless, many potential diagnostic pitfalls exist that can lead to false-positive and/or false-negative results. This article discusses several of the potential pitfalls in the cytologic evaluation of thyroid lesions.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, A. Gemelli Square, 1, Rome 20123, Italy
| | - Adebowale J Adeniran
- Department of Pathology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | - William C Faquin
- Department of Pathology, WRN 219, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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Rossi ED, Larocca LM, Pantanowitz L. Ancillary molecular testing of indeterminate thyroid nodules. Cancer Cytopathol 2019; 126 Suppl 8:654-671. [PMID: 30156775 DOI: 10.1002/cncy.22012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/11/2018] [Accepted: 04/11/2018] [Indexed: 12/11/2022]
Abstract
Cytological specimens from thyroid nodules are increasingly being adopted as the first available material for cost effectively managing patients in the era of personalized medicine. Cytology aspirates not only play a central role in providing accurate diagnoses, but are also being collected for ancillary molecular testing. Molecular analysis, including the evaluation of somatic mutations and other genomic alterations, has accordingly become well integrated in the cytological workup of thyroid lesions. Appropriately handled thyroid cytology preparations provide well-preserved and adequately cellular material with improved DNA/RNA quantity. The recent publication of the 2nd edition of The Bethesda System for Reporting Thyroid Cytopathology and the American Thyroid Association guidelines confirm the relevant role of molecular testing in the management of the different subcategories of indeterminate thyroid lesions. This review discusses the role of molecular testing for indeterminate thyroid nodules, including the recent introduction of the noninvasive, encapsulated follicular variant of papillary thyroid carcinoma (FVPTC), known also as noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP).
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Affiliation(s)
- Esther Diana Rossi
- Istituto di Anatomia Patologica, Fondazione Policlinico Universitario, "Agostino Gemelli" Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Maria Larocca
- Istituto di Anatomia Patologica, Fondazione Policlinico Universitario, "Agostino Gemelli" Università Cattolica del Sacro Cuore, Rome, Italy
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh
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Rossi ED, Pantanowitz L, Faquin WC. The Role of Molecular Testing for the Indeterminate Thyroid FNA. Genes (Basel) 2019; 10:genes10100736. [PMID: 31547603 PMCID: PMC6826845 DOI: 10.3390/genes10100736] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/13/2019] [Accepted: 09/18/2019] [Indexed: 01/21/2023] Open
Abstract
Thyroid nodules are common in the adult population where a majority are benign and only 4.0% to 6.5% are malignant. Fine needle aspiration (FNA) is a key method used in the early stages to evaluate and triage patients with thyroid nodules. While a definitive cytological diagnosis is provided in more than 70–75% of all thyroid FNA cases, the group of indeterminate lesions offers a challenge in terms of interpretation and clinical management. Molecular testing platforms have been developed, are recognized as an option by the 2015 American Thyroid Association Guidelines, and are frequently used in conjunction with FNA as an integral part of the cytologic evaluation. In this review, the utility of molecular testing options for nodules assigned to the group of indeterminate thyroid FNAs is described.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, 00168 Rome, Italy.
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15232, USA.
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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Surgical Treatment in Papillary Thyroid Microcarcinoma. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2018; 52:244-248. [PMID: 32774085 PMCID: PMC7406556 DOI: 10.14744/semb.2018.45452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 12/18/2018] [Indexed: 11/20/2022]
Abstract
Despite the notable increasing incidence of papillary thyroid microcarcinoma (PTMC), the optimal treatment of the patients with PTMC remains controversial. Because of no consensus about its treatment, the suggested treatment varies from active surveillance alone to total thyroidectomy. Although the 2015 revised American Thyroid Association guideline recommends hemithyroidectomy as the first-line treatment, active surveillance has also been discussed and accepted as another approach for the patients with PTMC. However, the same guideline does not recommend fine needle aspiration biopsy for nodules sized <1 cm, even it is suspicious. In such situation, neither active surveillance nor hemithyroidectomy could be discussed, with a lack of objective cytologic data about the nodules sized <1 cm. In this situation, the decision to perform FNAB to the nodules <1 cm in size depends on the performer of the thyroid ultrasonography. In this invited review, we have discussed the diagnosis and prognostic factors for PTMCs. We have also discussed surgical strategies as the accepted the first-line treatment in patients with PTMC.
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10
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Ferrari SM, Fallahi P, Ruffilli I, Elia G, Ragusa F, Paparo SR, Ulisse S, Baldini E, Giannini R, Miccoli P, Antonelli A, Basolo F. Molecular testing in the diagnosis of differentiated thyroid carcinomas. Gland Surg 2018; 7:S19-S29. [PMID: 30175060 DOI: 10.21037/gs.2017.11.07] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Different genetic mutations and other molecular alterations in papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC) can be detected in fine-needle aspiration (FNA) of thyroid nodules, and can be used successfully to ameliorate cancer diagnosis and management of patients with thyroid nodules. The greatest experience has been obtained with the diagnostic use of BRAF mutation that is strongly specific for malignancy when detected using well-validated techniques. The strongest diagnostic result can be obtained testing FNA samples for a panel of mutations that typically involve TERT, BRAF, PAX8/PPARγ, RAS, and RET/PTC. Finding any of these mutations in a thyroid nodule provides strong indication for malignancy and helps to refine clinical management for a significant proportion of patients with indeterminate cytology. The use of molecular markers, as TERT, BRAF, PAX8/PPARγ, RAS, and RET/PTC, may be considered for patients with indeterminate FNA cytology (FNAC) to help guide management. In patients with indeterminate TIR3 FNA, the combination of precise molecular marker expression analysis with molecular mutations evaluations could ameliorate significantly the accuracy of cancer diagnosis. However other prospective studies are needed to identify more accurate molecular markers. Finally, the knowledge of these molecular pathways has permitted the development of new targeted therapies for aggressive TC.
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Affiliation(s)
| | - Poupak Fallahi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ilaria Ruffilli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giusy Elia
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesca Ragusa
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Salvatore Ulisse
- Department of Surgical Sciences, 'Sapienza' University of Rome, Rome, Italy
| | - Enke Baldini
- Department of Surgical Sciences, 'Sapienza' University of Rome, Rome, Italy
| | - Riccardo Giannini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Paolo Miccoli
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Alessandro Antonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fulvio Basolo
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
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Vuttariello E, Borra M, Mauriello E, Calise C, D'Andrea B, Capiluongo A, Fulciniti F, Cipolletta A, Monaco M, Pezzullo L, Chiappetta G. Multiplex PCR approach to simultaneously identify several mutations in fine needle cytology thyroid samples. Oncotarget 2018; 8:49351-49358. [PMID: 28537891 PMCID: PMC5564773 DOI: 10.18632/oncotarget.17656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 04/19/2017] [Indexed: 12/31/2022] Open
Abstract
The most frequent initial manifestation of thyroid cancer is the appearance of a nodule. More than 20% of the general population has a palpable thyroid nodule and the percentage rises to 70% based on ultrasound identification. In 95% of cases the nodule is simply a hyperplastic or benign lesion. The most reliable diagnostic test for thyroid nodules is fine needle aspiration (FNA), but cytological discrimination between malignant and benign follicular neoplasms remains difficult. Cytological analysis is now, almost routinely, being combined with molecular genetics to enable the pathologist to make a more objective diagnosis. In this study, we performed the molecular analysis using a new simplified procedure that involves a panel of BRAF, RAS, RET and RET/PTC gene mutations in easily obtainable FNA samples, in the attempt to improve the efficacy of the FNA diagnosis of thyroid nodules and thus patient management. In this new procedure, PCR and sequencing analysis are used to detect point mutations, and, in parallel, RT-PCR is used to detect the chimeric RET/PTC1 and RET/PTC3 transcripts in RNA extracted from FNA.
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Affiliation(s)
- Emilia Vuttariello
- Functional Genomics Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Marco Borra
- Molecular Biology and Bioinformatics Unit, Stazione Zoologica "A.Dorhn", Naples, Italy
| | - Elvira Mauriello
- Molecular Biology and Bioinformatics Unit, Stazione Zoologica "A.Dorhn", Naples, Italy
| | | | - Barbara D'Andrea
- Molecular Biology and Bioinformatics Unit, Stazione Zoologica "A.Dorhn", Naples, Italy.,CMO, Naples, Italy
| | - Anna Capiluongo
- Functional Genomics Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Franco Fulciniti
- Clinical Cytopathology Service, Institute of Pathology, Locarno, Switzerland
| | - Anna Cipolletta
- SC Anatomia Patologica e Citopatologia, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Mario Monaco
- Functional Genomics Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Luciano Pezzullo
- Thyroid Surgery Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Gennaro Chiappetta
- Functional Genomics Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
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12
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Vuttariello E, Biffali E, Pannone R, Capiluongo A, Monaco M, Sica V, Aiello C, Matuozzo M, Chiofalo MG, Botti G, Chiappetta G. Rapid methods to create a positive control and identify the PAX8/PPARγ rearrangement in FNA thyroid samples by molecular biology. Oncotarget 2018; 9:19255-19262. [PMID: 29721199 PMCID: PMC5922393 DOI: 10.18632/oncotarget.24995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/09/2018] [Indexed: 11/25/2022] Open
Abstract
Thyroid cancer is the most common malignancy of the endocrine system and includes well-differentiated forms, namely papillary and follicular carcinomas, and the poorly differentiated and undifferentiated forms that result from the transformation of thyroid follicular cells (anaplastic carcinomas). Notably, 5–10% of all thyroid cancers are medullary thyroid cancers that arise from parafollicular cells also known as C cells. The most common genetic mutations in papillary and follicular thyroid cancers are point mutations of the BRAF or RAS genes, while the most common chromosomal alterations are RET/PTC and PAX8/PPARγ rearrangements. The most frequent initial manifestation of thyroid cancer is the appearance of a nodule most of which are benign; indeed, less than 5% are malignant. However, some cases are misdiagnosed, and many patients undergo unnecessary surgery. Therefore, an accurate pre-surgery evaluation is crucial. The most reliable diagnostic test for thyroid nodules is fine needle aspiration (FNA) cytology, which accurately distinguishes between a benign and malignant lesion in most cases. However, cytological discrimination between malignant and benign follicular cancer is often difficult because of poor quality samples. Here we describe rapid methods to create a positive control and identify the PAX8/PPARγ rearrangement in FNA thyroid samples by molecular biology.
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Affiliation(s)
- Emilia Vuttariello
- Functional Genomics Unit, Istituto Nazionale Tumori -IRCCS -Fondazione G. Pascale, Napoli, Italia
| | - Elio Biffali
- Molecular Biology and Bioinformatics Unit, Stazione Zoologica "A. Dorhn", Naples, Italy
| | - Raimondo Pannone
- Molecular Biology and Bioinformatics Unit, Stazione Zoologica "A. Dorhn", Naples, Italy
| | - Anna Capiluongo
- Functional Genomics Unit, Istituto Nazionale Tumori -IRCCS -Fondazione G. Pascale, Napoli, Italia
| | - Mario Monaco
- Functional Genomics Unit, Istituto Nazionale Tumori -IRCCS -Fondazione G. Pascale, Napoli, Italia
| | - Valentina Sica
- Functional Genomics Unit, Istituto Nazionale Tumori -IRCCS -Fondazione G. Pascale, Napoli, Italia
| | | | - Marco Matuozzo
- Functional Genomics Unit, Istituto Nazionale Tumori -IRCCS -Fondazione G. Pascale, Napoli, Italia
| | - Maria Grazia Chiofalo
- Thyroid Surgery Unit, Istituto Nazionale Tumori -IRCCS -Fondazione G. Pascale, Napoli, Italia
| | - Gerardo Botti
- S.S.D. di Citopatologia e S.C. di Anatomia Patologica, Istituto Nazionale Tumori -IRCCS -Fondazione G. Pascale, Napoli, Italia
| | - Gennaro Chiappetta
- Functional Genomics Unit, Istituto Nazionale Tumori -IRCCS -Fondazione G. Pascale, Napoli, Italia
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Lu J, Hu S, Miccoli P, Zeng Q, Liu S, Ran L, Hu C. Non-invasive diagnosis of papillary thyroid microcarcinoma: a NMR-based metabolomics approach. Oncotarget 2018; 7:81768-81777. [PMID: 27835583 PMCID: PMC5348428 DOI: 10.18632/oncotarget.13178] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 10/22/2016] [Indexed: 02/06/2023] Open
Abstract
Papillary thyroid microcarcinoma (PTMC) is a subtype of papillary thyroid carcinoma (PTC). Because its diameter is less than 10 mm, diagnosing it accurately is difficult with traditional methods such as image examinations and FNA (Fine Needle Aspiration). Investigating the metabolic changes induced by PTMC may enhance the understanding of its pathogenesis and provide important information for a new diagnosis method and treatment plan. In this study, high resolution magic angle spin (HRMAS) spectroscopy and 1H-nuclear magnetic resonance (1H-NMR) spectroscopy were used to screen metabolic changes in thyroid tissues and plasma from PTMC patients respectively. The results revealed reduced levels of fatty acids and elevated levels of several amino acids (phenylalanine, tyrosine, lactate, serine, cystine, lysine, glutamine/glutamate, taurine, leucine, alanine, isoleucine and valine) in thyroid tissues, as well as reduced levels of amino acids such as valine, tyrosine, proline, lysine, leucine and elevated levels of glucose, mannose, pyruvate and 3-hydroxybutyrate in plasma, are involved in the metabolic alterations in PTMC. In addition, a receiver operating characteristic (ROC) curve model for PTMC prediction was able to classify cases with good sensitivity and specificity using 9 significant changed metabolites in plasma. This work illustrates that the NMR-based metabolomics approach is capable of providing more sensitive diagnostic results and more systematic therapeutic information for PTMC.
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Affiliation(s)
- Jinghui Lu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, P.R. China
| | - Sanyuan Hu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, P.R. China
| | - Paolo Miccoli
- Department of General Surgery, University of Pisa, Pisa 56126, Italy
| | - Qingdong Zeng
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, P.R. China
| | - Shaozhuang Liu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, P.R. China
| | - Lin Ran
- Medical College of Shandong University, Jinan 250012, P.R. China
| | - Chunxiao Hu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, P.R. China
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Abstract
BACKGROUND Different countries are currently reporting a substantial increase in the incidence rates of papillary thyroid microcarcinoma (PTMC). OBJECTIVE Presentation of diagnosis and surgical therapy of PTMC and discussion of a more conservative approach, such as active surveillance. MATERIAL AND METHODS Overview of the current guidelines from different countries and analysis of recent publications reporting the results of active surveillance of PTMC from Japan, Korea and the USA. RESULTS The majority of international guidelines for PTMC recommends thyroid lobectomy as the gold standard. Active surveillance as an alternative procedure is described in the Japanese guidelines (JSTS/JAES). Present surveillance studies including more than 1700 patients report a tumor growth in 8-14% of the cases during a median follow-up of up to 75 months. Tumor growth and lymph node metastases are detected most frequently in younger patients (below 40-50 years). CONCLUSION Active surveillance might serve as an alternative treatment option for older patients with PTMC. Since the median follow-up periods are currently not long enough, it seems difficult to draw definite conclusions of this procedure right now.
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Ko YS, Hwang TS, Kim JY, Choi YL, Lee SE, Han HS, Kim WS, Kim SK, Park KS. Diagnostic Limitation of Fine-Needle Aspiration (FNA) on Indeterminate Thyroid Nodules Can Be Partially Overcome by Preoperative Molecular Analysis: Assessment of RET/PTC1 Rearrangement in BRAF and RAS Wild-Type Routine Air-Dried FNA Specimens. Int J Mol Sci 2017; 18:ijms18040806. [PMID: 28417935 PMCID: PMC5412390 DOI: 10.3390/ijms18040806] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/28/2017] [Accepted: 04/07/2017] [Indexed: 01/21/2023] Open
Abstract
Molecular markers are helpful diagnostic tools, particularly for cytologically indeterminate thyroid nodules. Preoperative RET/PTC1 rearrangement analysis in BRAF and RAS wild-type indeterminate thyroid nodules would permit the formulation of an unambiguous surgical plan. Cycle threshold values according to the cell count for detection of the RET/PTC1 rearrangement by real-time reverse transcription-polymerase chain reaction (RT-PCR) using fresh and routine air-dried TPC1 cells were evaluated. The correlation of RET/PTC1 rearrangement between fine-needle aspiration (FNA) and paired formalin-fixed paraffin-embedded (FFPE) specimens was analyzed. RET/PTC1 rearrangements of 76 resected BRAF and RAS wild-type classical PTCs were also analyzed. Results of RT-PCR and the Nanostring were compared. When 100 fresh and air-dried TPC1 cells were used, expression of RET/PTC1 rearrangement was detectable after 35 and 33 PCR cycles, respectively. The results of RET/PTC1 rearrangement in 10 FNA and paired FFPE papillary thyroid carcinoma (PTC) specimens showed complete correlation. Twenty-nine (38.2%) of 76 BRAF and RAS wild-type classical PTCs had RET/PTC1 rearrangement. Comparison of RET/PTC1 rearrangement analysis between RT-PCR and the Nanostring showed moderate agreement with a κ value of 0.56 (p = 0.002). The RET/PTC1 rearrangement analysis by RT-PCR using routine air-dried FNA specimen was confirmed to be technically applicable. A significant proportion (38.2%) of the BRAF and RAS wild-type PTCs harbored RET/PTC1 rearrangements.
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Affiliation(s)
- Young Sin Ko
- Diagnostic Pathology Center, Seegene Medical Foundation, Seoul KS013, Korea.
- Molecular Genetics and Pathology, Department of Medicine, Graduate School of Konkuk University, Seoul KS013, Korea.
| | - Tae Sook Hwang
- Molecular Genetics and Pathology, Department of Medicine, Graduate School of Konkuk University, Seoul KS013, Korea.
- Department of Pathology, Konkuk University School of Medicine, Seoul KS013, Korea.
| | - Ja Yeon Kim
- Department of Pathology, Konkuk University School of Medicine, Seoul KS013, Korea.
| | - Yoon-La Choi
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul KS013, Korea.
| | - Seung Eun Lee
- Department of Pathology, Konkuk University Medical Center, Seoul KS013, Korea.
| | - Hye Seung Han
- Molecular Genetics and Pathology, Department of Medicine, Graduate School of Konkuk University, Seoul KS013, Korea.
- Department of Pathology, Konkuk University School of Medicine, Seoul KS013, Korea.
| | - Wan Seop Kim
- Molecular Genetics and Pathology, Department of Medicine, Graduate School of Konkuk University, Seoul KS013, Korea.
- Department of Pathology, Konkuk University School of Medicine, Seoul KS013, Korea.
| | - Suk Kyeong Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul KS013, Korea.
| | - Kyoung Sik Park
- Department of Surgery, Konkuk University School of Medicine, Seoul KS013, Korea.
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16
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Abstract
The detection of thyroid nodules, consisting of different diseases, represents a common finding in population. Their evaluation and diagnosis are mostly achieved with fine-needle aspiration cytology (FNAC). Even though the majority of thyroid nodules are correctly diagnosed, a total of 25% to 30% of them are classified "indeterminate" comprising lesions with varying risk of malignancy and different types of management. Although the number of thyroid FNACs, including small lesions, is increasing due to the reliance upon sonographic and cytologic interpretations, there are issues concerning cytomorphologic interpretation and interobserver reproducibility. Different classification systems have tried to better define the criteria for inclusion in specific categories and to therefore reduce the rate of indeterminate diagnoses such as atypia of undetermined significance, follicular neoplasms, and suspicious for malignancy. However, the support of ancillary techniques (eg, immunocytochemistry and molecular analysis) are reshaping morphologic diagnoses made on materials obtained from FNAC.
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17
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Kwon H, Kim WG, Eszlinger M, Paschke R, Song DE, Kim M, Park S, Jeon MJ, Kim TY, Shong YK, Kim WB. Molecular Diagnosis Using Residual Liquid-Based Cytology Materials for Patients with Nondiagnostic or Indeterminate Thyroid Nodules. Endocrinol Metab (Seoul) 2016; 31:586-591. [PMID: 27834083 PMCID: PMC5195836 DOI: 10.3803/enm.2016.31.4.586] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/20/2016] [Accepted: 09/22/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Molecular analysis for common somatic mutations in thyroid cancer can improve diagnostic accuracy of fine-needle aspiration cytology (FNAC) in the nondiagnostic or indeterminate category of thyroid nodules. In this study, we evaluated the feasibility of molecular diagnosis from residual liquid-based cytology (LBC) material after cytological diagnosis. METHODS This prospective study enrolled 53 patients with thyroid nodules diagnosed as nondiagnostic, atypia of undetermined significance (AUS), or follicular lesion of undetermined significance (FLUS) after FNAC. DNAs and RNAs were isolated from residual LBC materials. BRAF(V600E) and RAS point mutations, PAX8/peroxisome proliferator-activated receptor γ (PPARγ), RET/PTC1, and RET/PTC3 rearrangements were evaluated by real-time polymerase chain reaction and pyrosequencing. RESULTS All DNAs from 53 residual LBC samples could be analysed and point mutations were detected in 10 samples (19%). In 17 AUS nodules, seven samples (41%) had point mutations including BRAF (n=4), NRAS (n=2), and KRAS (n=1). In 20 FLUS nodules, three samples (15%) had NRAS point mutations. RNA from only one FLUS nodule could be analysed for rearrangements and there was no abnormality. CONCLUSION Molecular analysis for BRAF and RAS mutations was feasible in residual LBC materials and might be useful for diagnosis of indeterminate thyroid nodules.
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Affiliation(s)
- Hyemi Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Gu Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Markus Eszlinger
- Division of Endocrinology and Metabolism, Department of Oncology and Arnie Charbonneau Cancer Institute, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ralf Paschke
- Division of Endocrinology and Metabolism, Department of Oncology and Arnie Charbonneau Cancer Institute, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Dong Eun Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mijin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suyeon Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Ji Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Yong Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Kee Shong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Bae Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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18
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Ting S, Synoracki S, Bockisch A, Führer D, Schmid KW. [Clinical importance of thyroid gland cytology]. DER PATHOLOGE 2016; 36:543-52. [PMID: 26462485 DOI: 10.1007/s00292-015-0093-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The cytological evaluation of fine needle biopsies (FNB) of the thyroid gland crucially depends on a close cooperation between clinicians and cytopathologists. Scintigraphy, sonography as well as clinical data and patient history are necessary for a correct interpretation of the indications for FNB; moreover, these data are of outstanding importance for cytopathologists for the correct interpretation of the cytomorphological findings. This overview describes the present standards in the acquisition, technical workup and cytopathological interpretation of thyroid gland tissue obtained by FNB, particularly focusing on the rapidly growing relevance of additional molecular pathological investigations to increase the diagnostic accuracy of thyroid FNB.
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19
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Cañadas-Garre M, Becerra-Massare P, Moreno Casares A, Calleja-Hernández MÁ, Llamas-Elvira JM. Relevance of BRAF and NRAS mutations in the primary tumor and metastases of papillary thyroid carcinomas. Head Neck 2016; 38:1772-1779. [PMID: 27299298 DOI: 10.1002/hed.24517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Multifocality of papillary thyroid carcinoma (PTC) is common. BRAF and NRAS mutations are the most frequent genetic alterations in PTC. The purpose of this study was to determine the distribution and relevance of BRAFT1799A and NRAS mutations in PTC. METHODS BRAFT1799A and NRAS mutations were evaluated in 195 intrathyroid or metastatic foci from 29 patients with multifocal PTC. RESULTS BRAFT1799A mutation was positive in 46.7% of the 59 intrathyroid and 136 metastatic foci (91/195 foci). Heterogeneous BRAF pattern was observed in 51.7% patients (15/29 patients). Irrespective of BRAF status at diagnosis (thyroid or nodes), all patients with recurrent PTC presented BRAF-mutated metastases during follow-up. All foci were negative for NRAS mutations. CONCLUSION BRAF but not NRAS mutations were heterogeneously distributed among primary tumor, nodal sites, and recurrent disease. The BRAF status of metastases generated during the follow-up can differ from the status of foci at diagnosis. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1772-1779, 2016.
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Affiliation(s)
- Marisa Cañadas-Garre
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Patricia Becerra-Massare
- UGC Anatomía Patológica, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Antonia Moreno Casares
- Department of Clinical Analysis and Immunology, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Miguel Ángel Calleja-Hernández
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - José Manuel Llamas-Elvira
- Nuclear Medicine Department, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Granada, Spain
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20
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Su X, Jiang X, Xu X, Wang W, Teng X, Shao A, Teng L. Diagnostic value of BRAF (V600E)-mutation analysis in fine-needle aspiration of thyroid nodules: a meta-analysis. Onco Targets Ther 2016; 9:2495-509. [PMID: 27175084 PMCID: PMC4854268 DOI: 10.2147/ott.s101800] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Fine-needle aspiration (FNA) is a reliable method for preoperative diagnosis of thyroid nodules; however, about 10%–40% nodules are classified as indeterminate. The BRAFV600E mutation is the most promising marker for thyroid FNA. This meta-analysis was conducted to investigate the diagnostic value of BRAFV600E analysis in thyroid FNA, especially the indeterminate cases. Systematic searches were performed in PubMed, Web of Science, Scopus, Ovid, Elsevier, and the Cochrane Library databases for relevant studies prior to June 2015, and a total of 88 studies were ultimately included in this meta-analysis. Compared with FNA cytology, the synergism of BRAFV600E testing increased the diagnostic sensitivity from 81.4% to 87.4% and decreased the false-negative rate from 8% to 5.2%. In the indeterminate group, the mutation rate of BRAFV600E was 23% and varied in different subcategories (43.2% in suspicious for malignant cells [SMC], 13.77% in atypia of undetermined significance/follicular lesion of undetermined significance [AUS/FLUS], and 4.43% in follicular neoplasm/suspicious for follicular neoplasm [FN/SFN]). The sensitivity of BRAFV600E analysis was higher in SMC than that in AUS/FLUS and FN/SFN cases (59.4% vs 40.1% vs 19.5% respectively), while specificity was opposite (86.1% vs 99.5% vs 99.7% respectively). The areas under the summary receiver-operating characteristic curve also confirmed the diagnostic value of BRAFV600E testing in SMC and AUS/FLUS rather than FN/SFN cases. Therefore, BRAFV600E analysis can improve the diagnostic accuracy of thyroid FNA, especially indeterminate cases classified as SMC, and select malignancy to guide the extent of surgery.
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Affiliation(s)
- Xingyun Su
- Department of Surgical Oncology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Xiaoxia Jiang
- Department of Surgical Oncology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Xin Xu
- Department of Surgical Oncology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Weibin Wang
- Department of Surgical Oncology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Xiaodong Teng
- Department of Pathology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Anwen Shao
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Lisong Teng
- Department of Surgical Oncology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
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21
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Choi SH, Baek JH, Lee JH, Choi YJ, Ha EJ, Song DE, Kim JK, Chung KW, Kim TY, Kim WB, Shong YK. Initial clinical experience with BRAF(V600E) mutation analysis of core-needle biopsy specimens from thyroid nodules. Clin Endocrinol (Oxf) 2016. [PMID: 26215382 DOI: 10.1111/cen.12866] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The accurate diagnosis of thyroid nodules is important for making management decisions. The purpose of this study was to evaluate the feasibility of core-needle biopsy with BRAF(V600E) mutation analysis (CNB + BRAF(V600E) ) and to compare the clinical usefulness of CNB + BRAF(V600E) and fine-needle aspiration with BRAF(V600E) mutation analysis (FNA + BRAF(V600E) ) in the diagnosis of thyroid malignancy. DESIGN, PATIENTS AND MEASUREMENTS The results of BRAF(V600E) mutation analyses of 820 nodules from 820 patients (153 men, 667 women; mean age, 51·1 years), who underwent CNB + BRAF(V600E) (n = 256) or FNA + BRAF(V600E) (n = 564) between January 2011 and March 2012 were retrospectively evaluated. The feasibility of CNB + BRAF(V600E) was assessed by comparing its rate of detection of BRAF(V600E) mutations and positive predictive value with those of FNA + BRAF(V600E) . The clinical usefulness of CNB + BRAF(V600E) was determined by comparing rates of inconclusive results, the additional value of BRAF(V600E) mutation analysis, diagnostic surgery and diagnostic performance with those of FNA + BRAF(V600E) . RESULTS CNB + BRAF(V600E) and FNA + BRAF(V600E) had similar rates of BRAF(V600E) mutation detection (66·3% vs 64·4%, P = 0·883) and positive predictive value (100·0% vs 96·6%, P = 0·135). CNB + BRAF(V600E) had a significantly higher diagnostic accuracy rate (95·7% vs 85·9%, P < 0·001), and significantly lower rates of inconclusive results (8·2% vs 51·8%, P < 0·001), and diagnostic surgery (8·9% vs 22·3%, P = 0·006), than FNA + BRAF(V600E) . CONCLUSIONS The greater diagnostic performance of CNB + BRAF(V600E) and its lower rate of inconclusive results than FNA + BRAF(V600E) suggest that CNB + BRAF(V600E) can reduce rates of preventable diagnostic surgery.
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Affiliation(s)
- Sang Hyun Choi
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Young Jun Choi
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Eun Ju Ha
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
- Department of Radiology, Ajou University School of Medicine, Yeongtong-Gu, Suwon, Korea
| | - Dong Eun Song
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Jae Kyun Kim
- Department of Radiology, Chung-Ang University College of Medicine, Dongjak-gu, Seoul, Korea
| | - Ki-Wook Chung
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Tae Yong Kim
- Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Won Bae Kim
- Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Young Kee Shong
- Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
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THY3 cytology: What surgical treatment? Retrospective study and literature review. Int J Surg 2016; 28 Suppl 1:S59-64. [DOI: 10.1016/j.ijsu.2015.05.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 05/06/2015] [Accepted: 05/22/2015] [Indexed: 12/28/2022]
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Fnais N, Soobiah C, AL-Qahtani K, Hamid JS, Perrier L, Straus SE, Tricco AC. Diagnostic value of fine needle aspiration BRAFV600E mutation analysis in papillary thyroid cancer: a systematic review and meta-analysis. Hum Pathol 2015; 46:1443-54. [DOI: 10.1016/j.humpath.2015.06.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 05/20/2015] [Accepted: 06/03/2015] [Indexed: 01/15/2023]
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24
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Song YS, Lim JA, Park YJ. Mutation Profile of Well-Differentiated Thyroid Cancer in Asians. Endocrinol Metab (Seoul) 2015; 30:252-62. [PMID: 26435130 PMCID: PMC4595348 DOI: 10.3803/enm.2015.30.3.252] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 08/20/2015] [Accepted: 08/27/2015] [Indexed: 12/14/2022] Open
Abstract
Recent advances in molecular diagnostics have led to significant insights into the genetic basis of thyroid tumorigenesis. Among the mutations commonly seen in thyroid cancers, the vast majority are associated with the mitogen-activated protein kinase pathway. B-Raf proto-oncogene (BRAF) mutations are the most common mutations observed in papillary thyroid cancers (PTCs), followed by RET/PTC rearrangements and RAS mutations, while follicular thyroid cancers are more likely to harbor RAS mutations or PAX8/peroxisome proliferator-activated receptor γ (PPARγ) rearrangements. Beyond these more common mutations, alterations in the telomerase reverse transcriptase (TERT) promoter have recently been associated with clinicopathologic features, disease prognosis, and tumorigenesis in thyroid cancer. While the mutations underlying thyroid tumorigenesis are well known, the frequency of these mutations is strongly associated with geography, with clear differences reported between Asian and Western countries. Of particular interest is the prevalence of BRAF mutations, with Korean patients exhibiting the highest rate of BRAF-associated thyroid cancers in the world. Here, we review the prevalence of each of the most common mutations in Asian and Western countries, and identify the characteristics of well-differentiated thyroid cancer in Asians.
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Affiliation(s)
- Young Shin Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Ah Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
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25
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Choi SH, Baek JH, Lee JH, Choi YJ, Song DE, Chung KW, Kim TY, Shong YK. Evaluation of the Clinical Usefulness of BRAFV600E Mutation Analysis of Core-Needle Biopsy Specimens in Thyroid Nodules with Previous Atypia of Undetermined Significance or Follicular Lesions of Undetermined Significance Results. Thyroid 2015; 25:897-903. [PMID: 25978151 DOI: 10.1089/thy.2014.0606] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND The accurate diagnosis of thyroid nodules is important for making management decisions. The purpose of this study is to evaluate the clinical usefulness of BRAF(V600E) mutation analysis with core-needle biopsy (CNB+BRAF(V600E)) in thyroid nodules with previous atypia of undetermined significance (AUS) or follicular lesions of undetermined significance (FLUS) results. MATERIALS AND METHODS From January 2011 to December 2012, 590 CNB+BRAF(V600E) mutation analyses were performed. We analyzed 200 nodules from 200 patients with previous AUS/FLUS results (22 men, 178 women; mean age, 48.6 years). The clinical usefulness of CNB+BRAF(V600E) was assessed by comparing the rates of conclusive results, the additional value of BRAF(V600E) mutation analysis, diagnostic performances, and therapeutic/diagnostic surgery results with those of CNB alone. For the subgroup analysis, the study patients were divided into those with nodules with previous AUS results and those with previous FLUS results. RESULTS All CNB+BRAF(V600E) procedures were well-tolerated. CNB+BRAF(V600E) did not show significantly better diagnostic performance than CNB alone in thyroid nodules with previous AUS/FLUS results. However, the conclusive result rate of CNB+BRAF(V600E) was improved in thyroid nodules with previous AUS/FLUS results (76.5% vs. 73.0%, p=0.016), especially with previous AUS results (81.1% vs. 76.4%, p=0.031). Of the 56 previous AUS result thyroid nodules with surgical management, BRAF(V600E) mutation analysis led to therapeutic surgery in 5.4% by decreasing unnecessary diagnostic surgery. CONCLUSIONS In general, CNB+BRAF(V600E) did not show significantly higher diagnostic accuracy than CNB alone. Although CNB+BRAF(V600E) may add additional value in nodules with previous AUS results, routinely adding BRAF(V600E) mutation analysis to CNB is not recommended.
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Affiliation(s)
- Sang Hyun Choi
- 1 Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine , Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Jung Hwan Baek
- 1 Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine , Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Jeong Hyun Lee
- 1 Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine , Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Young Jun Choi
- 1 Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine , Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Dong Eun Song
- 2 Department of Pathology, University of Ulsan College of Medicine , Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Ki-Wook Chung
- 3 Department of Surgery, University of Ulsan College of Medicine , Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Tae Yong Kim
- 4 Department of Endocrinology and Metabolism, University of Ulsan College of Medicine , Asan Medical Center, Songpa-Gu, Seoul, Korea
| | - Young Kee Shong
- 4 Department of Endocrinology and Metabolism, University of Ulsan College of Medicine , Asan Medical Center, Songpa-Gu, Seoul, Korea
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Rossi ED, Martini M, Bizzarro T, Capodimonti S, Cenci T, Lombardi CP, Pontecorvi A, Fadda G, Larocca LM. UncommonBRAFmutations in the follicular variant of thyroid papillary carcinoma: New insights. Cancer Cytopathol 2015; 123:593-602. [DOI: 10.1002/cncy.21586] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 06/23/2015] [Accepted: 06/23/2015] [Indexed: 01/21/2023]
Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Tommaso Bizzarro
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Sara Capodimonti
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Tonia Cenci
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery, “Agostino Gemelli” School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Alfredo Pontecorvi
- Division of Endocrinology, “Agostino Gemelli” School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine; Catholic University of the Sacred Heart; Rome Italy
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Witt RL, Sukumar VR, Gerges F. Surgeon-performed ultrasound-guided FNAC with on-site cytopathology improves adequacy and accuracy. Laryngoscope 2015; 125:1633-6. [DOI: 10.1002/lary.25214] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/19/2014] [Accepted: 01/22/2015] [Indexed: 01/21/2023]
Affiliation(s)
- Robert L. Witt
- Department of Otolaryngology-Head and Neck Surgery; Thomas Jefferson University; Philadelphia Pennsylvania U.S.A
- Department of Biological Sciences; University of Delaware; Newark U.S.A
- Head and Neck Multidisciplinary Clinic; Helen F. Graham Cancer Center, Christiana Care; Newark U.S.A
| | - V. Raman Sukumar
- Jefferson Integrated Bioscience Program; Thomas Jefferson University; Philadelphia Pennsylvania U.S.A
- Doctors Pathology Services; Dover Delaware U.S.A
| | - Fady Gerges
- Doctors Pathology Services; Dover Delaware U.S.A
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Fallahi P, Giannini R, Miccoli P, Antonelli A, Basolo F. Molecular diagnostics of fine needle aspiration for the presurgical screening of thyroid nodules. Curr Genomics 2014; 15:171-7. [PMID: 24955024 PMCID: PMC4064556 DOI: 10.2174/1389202915999140404100347] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 01/18/2014] [Accepted: 01/22/2014] [Indexed: 12/17/2022] Open
Abstract
"The incidence of thyroid cancer, the most common endocrine malignancy, is rising. The two most common types of thyroid cancer are papillary and follicular" thyroid carcinomas. "Fine-needle aspiration (FNA) of thyroid nodules" can permit to detect many genetic mutations and other molecular alterations, including RAS and BRAF point mutations, PAX8/peroxisome proliferator-activated receptor (PPAR)γ and "RET/PTC rearrangements, occurring in thyroid papillary and follicular carcinomas" (more than 70% of cases), which can be used successfully to improve the diagnosis "and the management of patients with thyroid nodules". The most extensive experience has been accumulated with "the diagnostic use of BRAF mutation", which is highly specific for malignancy. "Testing FNA samples for a panel of mutations" that typically includes RAS, BRAF, PAX8/PPARγ and RET/PTC could permit to achieve the biggest diagnostic impact. "The accuracy of cancer diagnosis in thyroid nodules could be improved significantly using these and other emerging molecular markers".
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Affiliation(s)
- Poupak Fallahi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | - Riccardo Giannini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Paolo Miccoli
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | | | - Fulvio Basolo
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
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Poller DN, Glaysher S, Agrawal A, Caldera S, Kim D, Yiangou C. BRAF V600 co-testing in thyroid FNA cytology: short-term experience in a large cancer centre in the UK. J Clin Pathol 2014; 67:684-9. [PMID: 24873948 DOI: 10.1136/jclinpath-2014-202348] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIMS To ascertain whether BRAF V600 mutational analysis is useful for diagnosis of thyroid cancer in thyroid fine needle aspirate (FNA). METHODS Over 8 months thyroid FNAs reported as Thy 3F (neoplasm possible/suggestive of follicular neoplasm), Thy4 (suspicious of malignancy) and Thy 5 (malignant) were tested for BRAF V600 mutation and managed as malignant if mutations were present. RESULTS Of 207 FNAs from 176 patients, 5 were Thy 5, 19 Thy 4, 36 Thy 3f, 13 Thy 3a, 84 Thy 2 and 50 Thy 1. 11 Thy 3f, 15 Thy 4 and 3 Thy 5 FNAs were tested for BRAF V600 mutation. 0 Thy 3F cases, 6 Thy 4 and 1 Thy 5 (24% of the total tested) showed evidence of mutation. Four patients with BRAF V600 mutation underwent surgery to remove all thyroid tissue, two patients received a lobectomy and one patient is awaiting thyroidectomy. All patients with BRAF V600 mutation were found to have malignancy on final histology, with a diagnostic sensitivity for malignancy excluding coincidental microcarcinoma of 43% and specificity of 100%. CONCLUSIONS BRAF V600 mutational analysis can enable single-stage total thyroidectomy for carcinoma if gene mutation is present in preoperative FNA. BRAF V600 co-testing may reduce the need for completion thyroidectomy with implied cost savings and lower patient morbidity associated with completion thyroidectomy when the cytology is inconclusive but where BRAF V600 mutation is identified in preoperative thyroid FNA.
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Affiliation(s)
- David N Poller
- Departments of Pathology and Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - Sharon Glaysher
- Departments of Pathology and Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - Avi Agrawal
- Portsmouth Acute Hospitals, Portsmouth, Hampshire, UK
| | | | - Dae Kim
- Portsmouth Acute Hospitals, Portsmouth, Hampshire, UK
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31
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Update on the molecular diagnosis and targeted therapy of thyroid cancer. Med Oncol 2014; 31:973. [PMID: 24788398 DOI: 10.1007/s12032-014-0973-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 04/18/2014] [Indexed: 02/07/2023]
Abstract
Thyroid cancer (TC) is the most common endocrine malignancy with steadily increasing incidence over the past few decades. Although standard strategies for the management of TC offer optimal outcomes in TC patients with favorable histological types at early stage, challenges arising from diagnosis and therapy still exist during clinical practice. A number of genetic alterations have been described in thyroid cancer, which provides an unprecedented opportunity for the identification of novel diagnostic and prognostic molecular markers as well as novel therapeutic targets. Molecular-targeted therapies, which have been investigated recently with increasing success, may prove to be a breakthrough in patients with advanced, radioiodine-refractory thyroid cancers. This review summarizes the latest progression in molecular diagnosis and targeted therapy of TC.
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Thyroglossal duct cyst cancer most likely arises from a thyroid gland remnant. Virchows Arch 2014; 465:67-72. [PMID: 24777145 DOI: 10.1007/s00428-014-1583-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/08/2014] [Accepted: 04/17/2014] [Indexed: 10/25/2022]
Abstract
Thyroglossal duct cancer is a rare entity, occurring in 1.5 % of all thyroglossal duct cysts (TDC). A definitive consensus about its neoplastic origin has not been established as two contrasting theories exist, one proposing an origin in extra-thyroid remnants and the other a metastatic localization of a primary thyroid cancer. We compare morphological and molecular characteristics of both thyroglossal and thyroid carcinomas in a case series from our institute. We evaluated histology of 80 TDC. In 12 cases, prior cytological evaluation had been performed by liquid-based cytology (LBC). The BRAF gene was examined for mutations, and the histology of both thyroglossal duct and synchronous thyroid carcinoma was reevaluated. In 9 out of 80 (11 %) TDC cases, a papillary thyroid cancer (PTC) was diagnosed. In five out of nine (56 %) thyroglossal carcinomas, a synchronous thyroid cancer was diagnosed: 3 PTC and 2 follicular variant PTC (FVPC). In five thyroglossal carcinomas, mutated BRAF (V600E) was found, three in PTC and in thyroglossal as well as in the synchronous tumor in the thyroid. All the patients are in a disease-free status and still alive. Our results suggest that the majority of thyroglossal carcinomas most likely develop as a primary malignancy from a thyroid remnant. Neither the presence of V600E BRAF mutations nor that of a well-differentiated thyroid carcinoma changed the outcome or disease-free survival. We suggest that a diagnosis of thyroglossal carcinoma should be followed by a detailed evaluation of the thyroid gland. In the absence of clinical and radiological thyroid alterations, follow-up as for thyroid cancer is the correct management.
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Rossi ED, Martini M, Capodimonti S, Cenci T, Straccia P, Angrisani B, Ricci C, Lanza P, Lombardi CP, Pontecorvi A, Larocca LM, Fadda G. Analysis of immunocytochemical and molecular BRAF expression in thyroid carcinomas: A cytohistologic institutional experience. Cancer Cytopathol 2014; 122:527-35. [DOI: 10.1002/cncy.21416] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 02/10/2014] [Accepted: 02/11/2014] [Indexed: 01/21/2023]
Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology; “Agostino Gemelli” School of Medicine; Catholic University of Sacred Heart; Rome Italy
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology; “Agostino Gemelli” School of Medicine; Catholic University of Sacred Heart; Rome Italy
| | - Sara Capodimonti
- Division of Anatomic Pathology and Histology; “Agostino Gemelli” School of Medicine; Catholic University of Sacred Heart; Rome Italy
| | - Tonia Cenci
- Division of Anatomic Pathology and Histology; “Agostino Gemelli” School of Medicine; Catholic University of Sacred Heart; Rome Italy
| | - Patrizia Straccia
- Division of Anatomic Pathology and Histology; “Agostino Gemelli” School of Medicine; Catholic University of Sacred Heart; Rome Italy
| | - Basilio Angrisani
- Division of Anatomic Pathology and Histology; “Agostino Gemelli” School of Medicine; Catholic University of Sacred Heart; Rome Italy
| | - Costantino Ricci
- Division of Anatomic Pathology and Histology; “Agostino Gemelli” School of Medicine; Catholic University of Sacred Heart; Rome Italy
| | - Paola Lanza
- Division of Anatomic Pathology and Histology; “Agostino Gemelli” School of Medicine; Catholic University of Sacred Heart; Rome Italy
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery; “Agostino Gemelli” School of Medicine; Catholic University of Sacred Heart; Rome Italy
| | - Alfredo Pontecorvi
- Division of Endocrinology; “Agostino Gemelli” School of Medicine; Catholic University of Sacred Heart; Rome Italy
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology; “Agostino Gemelli” School of Medicine; Catholic University of Sacred Heart; Rome Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology; “Agostino Gemelli” School of Medicine; Catholic University of Sacred Heart; Rome Italy
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Abstract
According to the literature, thyroid nodules (TNs) are quite rare in the first two decades of life and are predominantly non-cancerous, although cancerous TNs are more common in the first two decades of life than in adults. Therefore, it is important for clinicians to distinguish benign from malignant lesions preoperatively because the latter require a total thyroidectomy with or without neck lymph node dissection. A careful work-up and a fine-needle aspiration biopsy (FNAB) are mandatory to improve the preoperative diagnosis. High-resolution thyroid ultrasound and real-time elastosonography are adjuvant presurgical tools in selecting patients for surgery, particularly those with indeterminate or non-diagnostic cytology. Elevated thyroid-stimulating hormone (TSH) level in a patient with a thyroid nodule is a new laboratory predictor of thyroid cancer risk. The majority of thyroid carcinomas derive from the follicular cell, whereas medullary thyroid carcinoma (MTC) derives from calcitonin-producing cells. Patients with MTC are screened for germ-line RET mutations to detect carriers and identify family members for prophylactic or therapeutic thyroidectomy.
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Affiliation(s)
- Marek Niedziela
- Department of Paediatric Endocrinology and Rheumatology, 2nd Chair of Paediatrics, Poznan University of Medical Sciences, 27/33 Szpitalna Street, 60-572 Poznan, Poland.
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Incidence and Predictive Factors of Inadequate Fine-Needle Aspirates forBRAFV600EMutation Analysis in Thyroid Nodules. AJR Am J Roentgenol 2014; 202:391-6. [DOI: 10.2214/ajr.12.10291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abedi-Ardekani B, Vielh P. Is liquid-based cytology the magic bullet for performing molecular techniques? Acta Cytol 2014; 58:574-81. [PMID: 25277086 DOI: 10.1159/000366260] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 07/31/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The role of pathology has evolved from the first microscopic definitions of diseases by Virchow to the new concept of molecular cytopathology. The management of diseases is now a multidisciplinary approach with the translation of morphological, imagery and molecular findings to therapeutic protocols. Obtaining the most reliable diagnostic material is the essential part of the medical management of patients. STUDY DESIGN Here, we try to gain a concise insight into the available data regarding the role of cytology in the application of molecular techniques, focusing on cancer cytopathology. RESULTS Obtaining cytological material is now feasible by different methods, and in some cases it is the only possible approach to a lesion which is not easily accessible for tissue sampling. The methods of obtaining cytological material have evolved in recent years in parallel with rapid advances in high-throughput molecular techniques, opening new windows for the diagnosis and management of diseases. CONCLUSIONS Different kinds of cytological material are reliable for the application of molecular techniques. Cytological material obtained in a liquid base has advantages such as the better preservation of cytomorphological features and the use of the remaining liquid for nucleic acid extraction even after long storage and the application of molecular methods.
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Affiliation(s)
- Behnoush Abedi-Ardekani
- Translational Research Laboratory, Personalized Medicine, Gustave Roussy Cancer Campus, Villejuif, France
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37
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Rossi ED, Fadda G, Schmitt F. The nightmare of indeterminate follicular proliferations: when liquid-based cytology and ancillary techniques are not a moon landing but a realistic plan. Acta Cytol 2014; 58:543-51. [PMID: 25033918 DOI: 10.1159/000363439] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 05/06/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Thyroid nodules are a common finding in the general population, including both nonneoplastic and neoplastic entities. Fine-needle aspiration cytology (FNAC) is the first tool for evaluating thyroid nodules. In spite of its high diagnostic accuracy, 25% of nodules result in the category of follicular neoplasms (FN), with varying risk of malignancy and different management strategies. STUDY DESIGN The use of ancillary techniques is reshaping the practice of FNAC. These tools can significantly empower the morphological diagnosis and prognosis of thyroid nodules, allowing a more accurate prediction of the nature of the lesion. Several studies have underlined the role of single or multiple testing for the category of FN as strong indicators of cancer. Every cytological preparation can be used for the application of ancillary techniques but the introduction of liquid-based cytology (LBC) might facilitate the application. RESULTS Our experience involving an immunocytochemical panel made up of HBME-1 and galectin-3 pointed to an 81% overall diagnostic accuracy in discriminating between low and high risk of malignancy in FN. CONCLUSIONS The application of these techniques on LBC represents an adjunct to the morphological evaluation of FN. They represent a critical and challenging, but also a feasible, tool in the preoperative diagnoses, allowing specific prognostic and predictive details regardless of the cytological preparation. © 2014 S. Karger AG, Basel.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Agostino Gemelli School of Medicine, Catholic University of Sacred Heart, Rome, Italy
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Preoperative BRAF(V600E) mutation screening is unlikely to alter initial surgical treatment of patients with indeterminate thyroid nodules: A prospective case series of 960 patients. Cancer 2013; 120:1083-4. [DOI: 10.1002/cncr.28526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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39
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Bellevicine C, Vita GD, Malapelle U, Troncone G. Applications and limitations of oncogene mutation testing in clinical cytopathology. Semin Diagn Pathol 2013; 30:284-97. [DOI: 10.1053/j.semdp.2013.11.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Rodrigues HGC, DE Pontes AAN, Adan LF. Contribution of the BRAF oncogene in the pre-operative phase of thyroid carcinoma. Oncol Lett 2013; 6:191-196. [PMID: 23946802 PMCID: PMC3742634 DOI: 10.3892/ol.2013.1359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 04/24/2013] [Indexed: 01/21/2023] Open
Abstract
Numerous experiments have been conducted over the last few years aiming to identify molecular markers that show the diagnostic accuracy of fine-needle aspiration (FNA), particularly in thyroid lesions that are considered indeterminate. Using certain search arguments and previously defined criteria, 37 studies reporting experiments with the BRAF mutation in pre-operative FNA of the thyroid were selected from the electronic databases PUBMED, MEDLINE, SCOPUS and LILACS, in order to gather evidence with regard to the possible contribution of BRAF in the management of thyroid carcinoma. There were no cases positive for BRAF in follicular carcinomas (FTCs), Hürthle cell carcinomas (HCCs) or medullary thyroid carcinomas (MTCs). Among the 11 cases of anaplastic thyroid carcinomas (ATC), three showed positive results for the BRAF mutation. The number of cases positive for BRAF among the benign lesions was not significant. The average prevalence of BRAF-positive cases in papillary carcinomas (PTC) was 58.6%, while in follicular variants of papillary carcinoma (FVPTC), the average prevalence was 29.6%. For lesions diagnosed as indeterminate or suspicious, the average prevalence of BRAF positivity in PTC was 48.5%. The experiments included in the present study indicated a specificity of almost 100% and a high predominance of the BRAF mutation in PTC, distinguishing the marker in the planning and medical management of papillary carcinoma of the thyroid.
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Rossi ED, Martini M, Capodimonti S, Straccia P, Cenci T, Lombardi CP, Pontecorvi A, Larocca LM, Fadda G. Diagnostic and prognostic value of immunocytochemistry and BRAF mutation analysis on liquid-based biopsies of thyroid neoplasms suspicious for carcinoma. Eur J Endocrinol 2013; 168:853-9. [PMID: 23513230 DOI: 10.1530/eje-13-0023] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE In the field of fine-needle aspiration cytology, the category of suspicious for malignancy (SM) thyroid lesions, that bears 55-85% risk of malignant histology, is a challenging topic in which morphology alone is not always able to make a correct diagnosis. Recently, immunocytochemistry (ICC) has been referred to as helpful in differentiating low- and high-malignant risk lesions and BRAF activating mutations have been identified in a significant amount of papillary thyroid carcinomas (PTC). The introduction of the liquid-based cytology (LBC) may simplify the application of these techniques to thyroid cytology. DESIGN Our aim is to evaluate the diagnostic and prognostic role of both ICC and BRAF mutation for the SM category on LBC. METHODS From October 2010 through June 2011, 113 LBC cytological cases (including 37 SM and 76 PTC) underwent surgery. All cases were studied for BRAF mutation and ICC. RESULTS ICC resulted positive in 26 (86.6%) histologically malignant SM with 15 of which (40.5%) expressing a BRAF mutation. Overall, 63 cases showed a BRAF mutation resulting in PTC. Concerning the prognostic role of BRAF mutation for the two categories, we reported a significant correlation with multifocality, nodal involvement and extra-capsular invasion (P<0.0001). CONCLUSIONS Special techniques such as ICC and molecular markers might be successfully carried out on LBC-processed material. For both categories, ICC is more sensitive whereas BRAF analysis is an interesting support due to its high specificity adding a prognostic value in both SM and PTCs.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Agostino Gemelli School of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
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Witt RL, Ferris RL, Pribitkin EA, Sherman SI, Steward DL, Nikiforov YE. Diagnosis and management of differentiated thyroid cancer using molecular biology. Laryngoscope 2013; 123:1059-64. [PMID: 23404751 DOI: 10.1002/lary.23838] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2012] [Indexed: 01/21/2023]
Abstract
OBJECTIVES/HYPOTHESIS To define molecular biology in clinical practice for diagnosis, surgical management, and prognostication of differentiated thyroid cancer. DATA SOURCES Ovid Medline 2006-2012 REVIEW METHODS Manuscripts with clinical correlates. RESULTS Papillary thyroid carcinomas harbor point mutations of the BRAF and RAS genes or RET/PTC rearrangements, all of which activate the mitogen-activated protein kinase pathway. These mutually exclusive mutations are found in 70% of PTC. BRAF mutation is found in 45% of papillary thyroid cancer and is highly specific. Follicular carcinomas are known to harbor RAS mutation or PAX8/PPARγ rearrangement. These mutations are also mutually exclusive and identified in 70% of follicular carcinomas. Molecular classifiers measure the expression of a large number of genes on a microarray chip providing a substantial negative predictive value pending further validation. CONCLUSIONS 1) 20% to 30% of cytologically classified Follicular Neoplasms and Follicular Lesion of Undetermined Significance collectively are malignant on final pathology. Approximately 70% to 80% of thyroid lobectomies performed solely for diagnostic purposes are benign. Molecular alteration testing may reduce the number of unnecessary thyroid procedures, 2) may reduce the number of completion thyroidectomies, and 3) may lead to more individualized operative and postoperative management. Molecular testing for BRAF, RAS, RET/PTC, and PAX8/PPARγ for follicular lesion of undetermined significance and follicular neoplasm improve specificity, whereas molecular classifiers may add negative predictive value to fine needle aspiration diagnosis.
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Affiliation(s)
- Robert L Witt
- Department of Surgery, Helen F. Graham Cancer Center, Christiana Care, Newark, Delaware and Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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Controversies in the management and followup of differentiated thyroid cancer: beyond the guidelines. J Thyroid Res 2012; 2012:512401. [PMID: 23326756 PMCID: PMC3544283 DOI: 10.1155/2012/512401] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 12/12/2012] [Indexed: 01/21/2023] Open
Abstract
Thyroid cancer is among the most common endocrine malignancies. Genetic and environmental factors play an important role in the pathogenesis of differentiated thyroid cancer. Both have good prognosis but with frequent recurrences. Cancer staging is an essential prognostic part of cancer management. There are multiple controversies in the management and followup of differentiated thyroid cancer. Debate still exists with regard to the optimal surgical approach but trends toward a more conservative approach, such as lobectomy, are being more favored, especially in papillary thyroid cancer, of tumor sizes less than 4 cm, in the absence of other high-risk suggestive features. Survival of patients with well-differentiated thyroid cancer was adversely affected by lymph node metastases. Prophylactic central LN dissection did improve accuracy in staging and decrease postop TG level, but it had no effect on small-sized tumors. Conservative approach was more applied with regard to the need and dose of radioiodine given postoperatively. There have been several advancements in the management of radioiodine resistant advanced differentiated thyroid cancers. Appropriate followup is required based on risk stratification of patients postoperatively. Many studies are still ongoing in order to reach the optimal management and followup of differentiated thyroid cancer.
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Schäffer R, Schmid KW, Tötsch M. [Bethesda classification of fine needle punctures of the thyroid. Much ado about nothing really new?]. DER PATHOLOGE 2012; 33:324-30. [PMID: 22744413 DOI: 10.1007/s00292-012-1575-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The Bethesda system for reporting thyroid cytopathology was published in 2008 (Baloch et al. 2008, Cytojournal 5:6; Baloch et al. 2008, Diagn Cytopathol 36:425-437) offering a classification system which is closely related to clinical data. The aim was to ensure adequate terminology without risk of errors in understanding, to advise clinicians concerning therapeutic options in relationship to cytological diagnoses as well as to facilitate the comparison of cytology data at national and international levels. However, mainly due to specific US American (both medical and legal) demands, this classification system is not yet fully appreciated in most European countries. The reasons are various: (a) Criteria for representative material are much more restrictive than those commonly used and in Germany a higher number of (unnecessary) repunctures would be the consequence. (b) It remains doubtful whether the introduction of a new and rather heterogeneous category of "atypia of undetermined significance or follicular lesion of undetermined significance" would contribute to a substantial decrease of findings classified as "follicular neoplasia". Furthermore it is unlikely that clinicians would be willing to accept the recommended conservative approach with repuncture if a new diagnostic category is associated with a calculated risk of malignancy in 5-15% cases. (c) Until now an integration of new developments in molecular markers into the Bethesda system is missing. Thus, for experienced cytologists the Bethesda system for reporting thyroid cytopathology offers very limited benefits in comparison to the currently used, established and highly accepted classification systems. However, a positive argument remains the fact that an internationally accepted classification system may improve the comparability of the results of national and international studies on thyroid findings.
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MESH Headings
- Adenocarcinoma, Follicular/classification
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Papillary/classification
- Adenocarcinoma, Papillary/pathology
- Adenoma, Oxyphilic
- Biopsy, Fine-Needle
- Carcinoma/classification
- Carcinoma/pathology
- Carcinoma, Medullary/classification
- Carcinoma, Medullary/pathology
- Carcinoma, Squamous Cell/classification
- Carcinoma, Squamous Cell/pathology
- Cell Transformation, Neoplastic/classification
- Cell Transformation, Neoplastic/pathology
- Cross-Cultural Comparison
- Cytological Techniques/methods
- Diagnosis, Differential
- Europe
- Humans
- Lymphoma/classification
- Lymphoma/pathology
- Predictive Value of Tests
- Terminology as Topic
- Thyroid Diseases/pathology
- Thyroid Gland/pathology
- Thyroid Neoplasms/classification
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/secondary
- United States
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Affiliation(s)
- R Schäffer
- Funktionsbereich Zytopathologie, Institut für Pathologie, Universitätsklinikum Gießen-Marburg, Langhansstr. 10, 35385, Gießen, Deutschland.
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45
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Abstract
MicroRNAs (miRNAs) are small (20-24 nucleotides), non-coding ribonucleid acids, which regulate gene expression on the post-transcriptional level, thus influencing physiological processes including cellular growth, differentiation and apoptosis. Several miRNAs (e. g. miRNAs 146b, 221 and 222) have been shown to be consistently over-expressed in papillary thyroid carcinoma. The present overview describes and discusses the utilization and problems of miRNA analysis in material from thyroid nodules obtained by fine needle biopsy. Particularly the analysis of defined sets of miRNAs should improve the diagnostic value of this procedure and contribute to a better management of patients with cold thyroid nodules.
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46
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Rossi ED, Martini M, Capodimonti S, Lombardi CP, Pontecorvi A, Vellone VG, Zannoni GF, Larocca LM, Fadda G. BRAF(V600E) mutation analysis on liquid-based cytology-processed aspiration biopsies predicts bilaterality and lymph node involvement in papillary thyroid microcarcinoma. Cancer Cytopathol 2012. [DOI: 10.1002/cncy.21258] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology; Agostino Gemelli School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology; Agostino Gemelli School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Sara Capodimonti
- Division of Anatomic Pathology and Histology; Agostino Gemelli School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery; Agostino Gemelli School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Alfredo Pontecorvi
- Division of Endocrinology; Agostino Gemelli School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Valerio Gaetano Vellone
- Division of Anatomic Pathology and Histology; Agostino Gemelli School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Gian Franco Zannoni
- Division of Anatomic Pathology and Histology; Agostino Gemelli School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology; Agostino Gemelli School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology; Agostino Gemelli School of Medicine; Catholic University of the Sacred Heart; Rome Italy
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47
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Ferraz C, Rehfeld C, Krogdahl A, Precht Jensen EM, Bösenberg E, Narz F, Hegedüs L, Paschke R, Eszlinger M. Detection of PAX8/PPARG and RET/PTC rearrangements is feasible in routine air-dried fine needle aspiration smears. Thyroid 2012; 22:1025-30. [PMID: 23025542 PMCID: PMC3462388 DOI: 10.1089/thy.2011.0391] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND The diagnostic limitations of fine needle aspiration (FNA), like the indeterminate category, can be partially overcome by molecular analysis. As PAX8/PPARG and RET/PTC rearrangements have been detected in follicular thyroid carcinomas (FTCs) and papillary thyroid carcinomas (PTCs), their detection in FNA smears could improve the FNA diagnosis. To date, these rearrangements have never been analyzed in routine air-dried FNA smears, but only in frozen tissue, formalin-fixed paraffin-embedded (FFPE) tissue, and in fresh FNA material. Fixed routine air-dried FNA samples have hitherto been judged as generally not suitable for testing these rearrangements in a clinical setting. Therefore, the objective of the present study was to investigate the feasibility of extracting RNA from routine air-dried FNA smears for the detection of these rearrangements with real-time polymerase chain reaction (RT-PCR). METHODS A new method for RNA extraction from routine air-dried FNA smears was established, which allowed analysis for the presence of four variants of PAX8/PPARG and RET/PTC 1 and RET/PTC 3, which were analyzed in 106 routine FNA smears and the corresponding surgically obtained FFPE tissues using real-time quantitative PCR (RT-qPCR). To assess RNA quality, an intron-spanning PAX8 cDNA was amplified. RESULTS Acceptable RNA quality was obtained from 95% of the FNA samples and 92% of the FFPE samples. PAX8/PPARG was detected in 4 of 96 FFPEs and in 6 of 96 FNAs. PAX8/PPARG was present in 4 of 10 FTCs and in 3 of 42 follicular adenomas (FAs). Similarly, RET/PTC was found in 3 of 96 FFPEs and in 4 of 96 FNAs. Two of 21 PTC samples and 3 of 42 FA samples carried this rearrangement. CONCLUSION These data are the first to show the feasibility of extracting RNA from routine air-dried FNA smears for the detection of PAX8/PPARG and RET/PTC rearrangements with RT-qPCR. These promising methodological advances, if confirmed in larger series of FNA and FFPE samples, may lead to the introduction of molecular analysis of routine air-dried FNA smears in everyday practice.
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Affiliation(s)
- Carolina Ferraz
- Division of Endocrinology and Nephrology, University of Leipzig, Leipzig, Germany
- Department of Internal Medicine III, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Christian Rehfeld
- Division of Endocrinology and Nephrology, University of Leipzig, Leipzig, Germany
| | - Annelise Krogdahl
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | | | - Eileen Bösenberg
- Division of Endocrinology and Nephrology, University of Leipzig, Leipzig, Germany
| | | | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Ralf Paschke
- Division of Endocrinology and Nephrology, University of Leipzig, Leipzig, Germany
| | - Markus Eszlinger
- Division of Endocrinology and Nephrology, University of Leipzig, Leipzig, Germany
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48
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Reduction of false-negative papillary thyroid carcinomas by the routine analysis of BRAF(T1799A) mutation on fine-needle aspiration biopsy specimens: a prospective study of 814 thyroid FNAB patients. Ann Surg 2012; 255:986-92. [PMID: 22504197 DOI: 10.1097/sla.0b013e31824e8d70] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate prospectively the usefulness of the routine determination of BRAF(T1799A) mutation on thyroid fine-needle aspiration biopsy (FNAB) to detect cytopathology false negative papillary thyroid carcinomas (PTC) and, therefore, as a tool to improve the sensitivity of the preoperative cytopathological diagnosis of PTC in thyroid nodules. BACKGROUND FNAB is the most reliable diagnostic test to discriminate between malignant and benign thyroid nodules, but nondiagnostic results remain a clinical management dilemma. BRAF(T1799A) mutation is the most prevalent genetic alteration in thyroid cancers and is specific for PTC, characteristics that make it the most potentially helpful genetic tool to improve the diagnostic accuracy of FNAB. METHODS An exhaustive recruitment of all patients subjected to thyroid FNAB in our institution during 4 years was performed. BRAF(T1799A) mutation was determined on thyroid FNAB specimens by PCR and restriction fragment length polymorphism, plus direct sequencing in positive samples. RESULTS BRAF(T1799A) mutation on FNAB detected 47.2% (17/36) of PTC cases. It confirmed preoperatively 45.5% (5/11) of the PTC cases in the indeterminate category and decreased the rate of cytopathology false-negatives in 33.3% (6/18), improving the combined (BRAF(T1799A) mutation + cytopathological analysis) sensitivity of the detection of PTC on FNAB in 16.7%. CONCLUSIONS BRAF(T1799A) mutation improves the diagnosis of PTC on FNAB, mainly because of the detection of cytopathology false-negatives, and it can be helpful in the routine analysis of thyroid nodules, especially in clinical settings with moderate sensitivity to detect PTC on FNAB.
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49
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Abstract
PURPOSE OF REVIEW The molecular work-up of thyroid nodules on fine needle aspiration (FNA) cytology samples has given clinicians a new level of diagnostic information. We focus this review on the molecular techniques used in the diagnosis of thyroid cancer, especially BRAF, and the resulting management considerations that are raised. RECENT FINDINGS BRAF testing offers both diagnostic and prognostic information; it has been used along with the Bethesda Thyroid FNA Classification System to offer preoperative guidance in the management of thyroid nodules. Various authors have successfully utilized molecular panels on cytologic specimens including mutations and rearrangements such as RAS and RET/PTC. Preoperative mutation detection allows initial management decisions to be made with a greater clinical confidence. SUMMARY BRAF molecular testing holds promise as a possible diagnostic tool for indeterminate FNAs, and as a determinant for planning initial clinical management of thyroid nodules. Further developments in the molecular approach to thyroid cancer are expected to allow greater individualization of patient care.
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50
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Bauer AJ, Francis GL. Update on the molecular signature of differentiated thyroid cancer: clinical implications and potential opportunities. Expert Rev Endocrinol Metab 2011; 6:819-834. [PMID: 30780870 DOI: 10.1586/eem.11.68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
With the development and maturation of new technologies, there has been a steady incorporation of powerful new tools into the evaluation and management of thyroid nodules and thyroid cancer. An increasing number of reports on oncogene testing and molecular screening in fine-needle aspiration biopsy samples have been published. However, there remains a paucity of data and consensus on combining both conventional and molecular technologies to determine the diagnosis and/or prognosis of disease. All patients with differentiated thyroid cancer stand to benefit from the identification and incorporation of reliable molecular markers into clinical practice. Identification of reliable markers would allow for stratification of treatment, affording the medical and surgical teams an ability to individually tailor evaluation and treatment, applying aggressive therapy and monitoring only when clinically warranted. For the majority of patients with thyroid cancer, the incorporation of a validated, multifaceted molecular profiling system may not improve survival; however, there is great opportunity for these efforts to decrease the morbidity associated with our current approach.
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Affiliation(s)
- Andrew J Bauer
- a Pediatric Endocrinology, Department of Pediatrics, Walter Reed Army Medical Center, Washington, DC, USA.
- b Uniformed Services University, Bethesda, MD, USA
- c Thyroid Center, Division of Endocrinology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Gary L Francis
- d Division of Endocrinology, Department of Pediatrics, Children's Hospital of Richmond at The Commonwealth University Health System, Medical College of Virginia, Richmond, VA, USA
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